Managed Care

 

Drug tier coverage differs by plan type

MANAGED CARE September 2011. © MediMedia USA
The Formulary Files

Drug tier coverage differs by plan type

MANAGED CARE September 2011. ©MediMedia USA

While 99 percent of insured workers have coverage for prescription drugs, how that coverage is distributed differs by plan type. Overall, 78 percent of workers are enrolled in plans with three, four, or more tiers for prescription drugs. That number hasn’t changed from last year, according to the most recent Kaiser Family Foundation report, Employer Health Benefits 2010.

High deductible health plans with a savings option (HDHP/SO) are slightly different from other plans. Kaiser says only 53 percent of covered workers in an HDHP/SO are in a plan with three or more tiers of drug cost-sharing. Thirty percent are in plans that pay 100 percent of prescription costs once the deductible is met. The survey treats high-deductible plans that can be paired with a savings option as a distinct plan type even if the plan would otherwise be considered a PPO, an HMO, or a POS plan.

The report also says that 15 percent of companies offering health benefits offered an HDHP/SO in 2010. Of companies with 1,000 or more workers, 34 percent offered an HDHP/SO, up from 28 percent in 2009.

Number of tiers by type of plan

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2010

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